Hepatocellular carcinoma in non-alcoholic fatty liver disease-a review of an emerging challenge facing clinicians  

作　　者：Daniel Geh Derek M.Manas Helen L.Reeves 

机构地区：[1]Northern Institute for Cancer Research [2]Institute of Cellular Medicine,Newcastle University,Newcastle upon Tyne,UK [3]Hepatopancreatobiliary Multidisciplinary Team,Newcastle upon Tyne Hospitals NHS Foundation Trust,Newcastle upon Tyne,UK

出　　处：《Hepatobiliary Surgery and Nutrition》2021年第1期59-75,共17页肝胆外科与营养（英文）

摘　　要：Importance:Non-alcoholic fatty liver disease(NAFLD)is a rapidly growing cause of chronic liver disease and is becoming a leading cause of hepatocellular carcinoma(HCC)in many developed countries.This presents major challenges for the surveillance,diagnosis and treatment of HCC.Objective:To discuss the clinical challenges faced by clinicians in managing the rising number of NAFLD-HCC cases.Evidence Review:MEDLINE,PubMed and Embase databases were searched using the keywords;NAFLD,HCC,surveillance,hepatectomy,liver transplantation,percutaneous ablation,transarterial chemoembolization(TACE),selective internal radiotherapy treatment(SIRT)and sorafenib.Relevant clinical studies were included.Findings:Current HCC surveillance programmes are inadequate because they only screen for HCC in patients with cirrhosis,whereas in NAFLD a significant proportion of HCC develops in the absence of cirrhosis.Consequently NAFLD patients often present with a more advanced stage of HCC,with a poorer prognosis.NAFLD-HCC patients also tend to be older and to have more co-morbidities compared to HCC of other etiologies.This limits the use of curative treatments such as liver resection and orthotopic liver transplantation(OLT).Evidence suggests that although NAFLD-HCC patients who undergo liver resection or OLT have worse perioperative and short-term outcomes,overall long-term survival is comparable to HCC of other etiologies.This highlights the importance of careful patient selection,pre-habilitation and perioperative planning for NAFLD-HCC patients being considered for surgical treatment.Careful consideration is also important for non-surgical treatments,although the evidence supporting treatment selection is frequently lacking,as these patients tend to be poorly represented in clinical trials.Locoregional therapies such as percutaneous ablation and TACE may be less well tolerated and less effective in NAFLD patients with obesity or diabetes.The tyrosine kinase inhibitor sorafenib may also be less effective.Conclusions and Relevance:This

关 键 词：Non-alcoholic fatty liver disease(NAFLD) hepatocellular carcinoma(HCC) liver transplantation HEPATECTOMY catheter ablation SORAFENIB population surveillance 

分 类 号：R73[医药卫生—肿瘤]